Identification of the external laryngeal nerve: its anatomical relations to inferior constrictor muscle, superior thyroid artery, and superior pole of the thyroid gland in Thais.

BACKGROUND: The external laryngeal nerve (ELN) is not routinely identified during thyroid surgery despite clear benefits from doing so. One reason is its anatomical variations, which differ from papers to papers. There were also very few studies of ELN in Thais, especially its relation to inferior constrictor muscle and tip of superior pole of the thyroid gland, which serve as important landmarks when identifying the ELN intraoperatively. OBJECTIVE: To describe the course of ELN and its relations to the inferior constrictor muscle, superior thyroid artery (STA), and tip of superior pole of the thyroid gland in Thais in order to serve as a guide for identification and preservation of the nerve. MATERIAL AND METHOD: One hundred thirty four ELNs from 68 cadavers with normal-sized thyroid glands and no signs of neck abnormality were studied Three areas were studied, (1) its relation to inferior constrictor muscle, (2) the nearest distance from the nerve to tip of the superior pole of the thyroid gland, and (3) the crossing point of the ELN and STA in relation to the tip of the superior pole of the thyroid gland. All distances were measured in mm using a vernier caliper. RESULTS: The three areas of the study were reported separately using established classifications and compared to the previous published papers. All ELNs run superficially, at the least on the upper portion of the inferior constrict muscle, rendering it more vulnerable to injury in Thais. CONCLUSION: The course of the ELN and its relations to nearby structures can vary considerably and are influenced by many factors. Nevertheless, these findings should encourage the surgeons to identify the ELN intraoperatively with meticulous dissection to minimize the risk of ELN injury.

Pancreatic cancer in an Asian population.

BACKGROUND AND OBJECTIVES: Most of the available data on pancreatic cancer are from Western countries. The aim was to characterize pancreatic cancer in Asian patients and to compare it with pancreatic cancer in Caucasians. MATERIALS AND METHODS: Inpatients with histologically proven pancreatic cancer were retrospectively recruited at King Chulalongkorn Memorial Hospital from January 2005 to December 2011. RESULTS: The study enrolled 100 patients (male:female = 55:45, mean age 62.7 ± 12.9 years). The amount of time between symptom onset and disease diagnosis was 59.89 ± 63.12 days. The common presenting symptoms included abdominal pain or discomfort (71%), weight loss (70%), and jaundice (60%). Fifty-three of the 100 patients had stage 4 pancreatic cancer. The most common metastatic organ was the liver (n = 42, 79.25%). The survival rates after 1 and 3 years were 24 and 6%, respectively. The overall median time for survival was 5.1 months (range, 3 days to 62.4 months). According to the multivariate analysis, the staging at the time of diagnosis, serum albumin level, and tumor size were found to independently affect the survival rate. Twenty-two patients underwent endoscopic ultrasound-fine-needle aspiration with the sensitivity rate of 86.4% (19/22). CONCLUSION: Because pancreatic cancer in Asians may be clinically similar to the disease in Caucasians, the goals of future research of the disease may also be similar in the two populations.